Top

Published in:

01-03-2018 | Review

Robotic versus laparoscopic right colectomy: an updated systematic review and meta-analysis

Authors: Leonardo Solaini, Francesca Bazzocchi, Davide Cavaliere, Andrea Avanzolini, Alessandro Cucchetti, Giorgio Ercolani

Published in: Surgical Endoscopy | Issue 3/2018

Abstract

Background

In the right colon surgery, there is a growing literature comparing the safety of robotic right colectomy (RRC) to that of laparoscopic right colectomy (LRC). With this paper we aim to systematically revise and meta-analyze the latest comparative studies on these two minimally invasive procedures.

Methods

A systematic review of studies published from 2000 to 2017 in the PubMed, Scopus, and Embase databases was performed. Primary endpoints were postoperative morbidity and mortality. Secondary endpoints were blood loss, conversion to open surgery, harvested lymph node anastomotic leak, postoperative hemorrhage, abdominal abscess, postoperative ileus, time to first flatus, non-surgical complications, wound infections, hospital stay, and incisional hernia and costs. A subgroup analysis was performed on those series presenting only extracorporeal anastomosis in both arms.

Results

After screening 355 articles, 11 articles with a total of 8257 patients were eligible for inclusion. Operative time was found to be significantly shorter for the laparoscopic procedures in the pooled analysis (SMD − 0.99 95% CI − 1.4 to − 0.6, p < 0.001). Conversion to open surgery was more common during laparoscopic procedures than during the robotic ones (RR 1.7; 95% CI 1.1–2.6, p = 0.02). No significant differences in mortality (RR 0.47; 95% CI 0.18–1.23, p = 0.124) and postoperative complications (RR 1.05; 95% CI 0.9–1.2, p = 0.5) were found between LRC versus RRC. The pooled mean time to first flatus was higher in the laparoscopic group (SMD 0.85 days; 95% CI 0.16–1.54, p = 0.016). Hospital costs were significantly higher in RRCs (SMD − 0.52; 95% CI − 0.52 to − 0.04, p = 0.035).

Conclusions

RRC can be regarded as a feasible and safe technique. Its superiority in terms of postoperative recovery must be confirmed by further large prospective series comparing RRC and LRC performed with the same anastomotic technique. RRC seemed to be associated with higher costs than LRC.

Formisano G, Misitano P, Giuliani G, Calamati G, Salvischiani L, Bianchi PP (2016) Laparoscopic versus robotic right colectomy: technique and outcomes. Updates Surg 68(1):63–69. https://doi.org/10.1007/s13304-016-0353-4 CrossRefPubMed

Zerey M, Hawver LM, Awad Z, Stefanidis D, Richardson W, Fanelli RD (2013) SAGES evidence-based guidelines for the laparoscopic resection of curable colon and rectal cancer. Surg Endosc 27(1):1–10. https://doi.org/10.1007/s00464-012-2592-x CrossRefPubMed

Casillas MA Jr, Leichtle SW, Wahl WL, Lampman RM, Welch KB, Wellock T, Madden EB, Cleary RK (2014) Improved perioperative and short-term outcomes of robotic versus conventional laparoscopic colorectal operations. Am J Surg 208(1):33–40. https://doi.org/10.1016/j.amjsurg.2013.08.028 CrossRefPubMed

deSouza AL, Prasad LM, Park JJ, Marecik SJ, Blumetti J, Abcarian H (2010) Robotic assistance in right hemicolectomy: is there a role? Dis Colon Rectum 53(7):1000–1006. https://doi.org/10.1007/DCR.0b013e3181d32096 CrossRefPubMed

Deutsch GB, Sathyanarayana SA, Gunabushanam V, Mishra N, Rubach E, Zemon H, Klein JD, Denoto G 3rd (2012) Robotic vs. laparoscopic colorectal surgery: an institutional experience. Surg Endosc 26 (4):956–963. https://doi.org/10.1007/s00464-011-1977-6 CrossRefPubMed

Park JS, Choi GS, Park SY, Kim HJ, Ryuk JP (2012) Randomized clinical trial of robot-assisted versus standard laparoscopic right colectomy. Br J Surg 99(9):1219–1226. https://doi.org/10.1002/bjs.8841 CrossRefPubMed

Rawlings AL, Woodland JH, Vegunta RK, Crawford DL (2007) Robotic versus laparoscopic colectomy. Surg Endosc 21(10):1701–1708. https://doi.org/10.1007/s00464-007-9231-y CrossRefPubMed

Lorenzon L, Bini F, Balducci G, Ferri M, Salvi PF, Marinozzi F (2016) Laparoscopic versus robotic-assisted colectomy and rectal resection: a systematic review and meta-analysis. Int J Colorectal Dis 31(2):161–173. https://doi.org/10.1007/s00384-015-2394-4 CrossRefPubMed

Petrucciani N, Sirimarco D, Nigri GR, Magistri P, La Torre M, Aurello P, D’Angelo F, Ramacciato G (2015) Robotic right colectomy: a worthwhile procedure? Results of a meta-analysis of trials comparing robotic versus laparoscopic right colectomy. J Minim Access Surg 11(1):22–28. https://doi.org/10.4103/0972-9941.147678 CrossRefPubMedPubMedCentral

10.

Rondelli F, Balzarotti R, Villa F, Guerra A, Avenia N, Mariani E, Bugiantella W (2015) Is robot-assisted laparoscopic right colectomy more effective than the conventional laparoscopic procedure? A meta-analysis of short-term outcomes. Int J Surg 18:75–82. https://doi.org/10.1016/j.ijsu.2015.04.044 CrossRefPubMed

11.

Xu H, Li J, Sun Y, Li Z, Zhen Y, Wang B, Xu Z (2014) Robotic versus laparoscopic right colectomy: a meta-analysis. World J Surg Oncol 12:274. https://doi.org/10.1186/1477-7819-12-274 CrossRefPubMedPubMedCentral

12.

Zarak A, Castillo A, Kichler K, de la Cruz L, Tamariz L, Kaza S (2015) Robotic versus laparoscopic surgery for colonic disease: a meta-analysis of postoperative variables. Surg Endosc 29(6):1341–1347. https://doi.org/10.1007/s00464-015-4197-7 CrossRefPubMed

13.

Delaney CP, Lynch AC, Senagore AJ, Fazio VW (2003) Comparison of robotically performed and traditional laparoscopic colorectal surgery. Dis Colon Rectum 46(12):1633–1639. https://doi.org/10.1097/01.DCR.0000098941.42470.D9 CrossRefPubMed

14.

Shin JY (2012) Comparison of short-term surgical outcomes between a robotic colectomy and a laparoscopic colectomy during early experience. J Korean Soc Coloproctol 28(1):19–26. https://doi.org/10.3393/jksc.2012.28.1.19 CrossRefPubMedPubMedCentral

15.

Davis BR, Yoo AC, Moore M, Gunnarsson C (2014) Robotic-assisted versus laparoscopic colectomy: cost and clinical outcomes. J Soc Laparoendosc Surg 18(2):211–224. https://doi.org/10.4293/108680813X13753907291035 CrossRef

16.

de’Angelis N, Lizzi V, Azoulay D, Brunetti F (2016) Robotic versus laparoscopic right colectomy for colon cancer: analysis of the initial simultaneous learning curve of a surgical fellow. J Laparoendosc Adv Surg Tech A 26(11):882–892. https://doi.org/10.1089/lap.2016.0321 CrossRefPubMed

17.

Dolejs SC, Waters JA, Ceppa EP, Zarzaur BL (2016) Laparoscopic versus robotic colectomy: a national surgical quality improvement project analysis. Surg Endosc. https://doi.org/10.1007/s00464-016-5239-5

18.

Kang J, Park YA, Baik SH, Sohn SK, Lee KY (2016) A comparison of open, laparoscopic, and robotic surgery in the treatment of right-sided colon cancer. Surg Laparosc Endosc Percutan Tech 26(6):497–502. https://doi.org/10.1097/SLE.0000000000000331 CrossRefPubMed

19.

Lujan HJ, Plasencia G, Rivera BX, Molano A, Fagenson A, Jane LA, Holguin D (2017) Advantages of robotic right colectomy with intracorporeal anastomosis. Surg Laparosc Endosc Percutan Tech. https://doi.org/10.1097/SLE.0000000000000384

20.

Trastulli S, Coratti A, Guarino S, Piagnerelli R, Annecchiarico M, Coratti F, Di Marino M, Ricci F, Desiderio J, Cirocchi R, Parisi A (2015) Robotic right colectomy with intracorporeal anastomosis compared with laparoscopic right colectomy with extracorporeal and intracorporeal anastomosis: a retrospective multicentre study. Surg Endosc 29(6):1512–1521. https://doi.org/10.1007/s00464-014-3835-9 CrossRefPubMed

21.

Moher D, Liberati A, Tetzlaff J, Altman DG (2010) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 8(5):336–341. https://doi.org/10.1016/j.ijsu.2010.02.007 CrossRefPubMed

22.

Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17(1):1–12. https://doi.org/10.1016/0197-2456(95)00134-4 CrossRefPubMed

23.

Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73(9):712–716. https://doi.org/10.1046/j.1445-2197.2003.02748.x CrossRefPubMed

24.

Freeman MF, Tukey JW (1950) Transformations related to the angular and the square root. Ann Math Statist (4):607–611. https://doi.org/10.1214/aoms/1177729756

25.

Hozo SP, Djulbegovic B, Hozo I (2005) Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 5(1):13. https://doi.org/10.1186/1471-2288-5-13 CrossRefPubMedPubMedCentral

26.

Higgins JPT, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560CrossRefPubMedPubMedCentral

Title: Robotic versus laparoscopic right colectomy: an updated systematic review and meta-analysis
Authors: Leonardo Solaini
Francesca Bazzocchi
Davide Cavaliere
Andrea Avanzolini
Alessandro Cucchetti
Giorgio Ercolani
Publication date: 01-03-2018
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 3/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-017-5980-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Robotic versus laparoscopic right colectomy: an updated systematic review and meta-analysis

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2018

Safety and prognostic impact of prophylactic laparoscopic superior mesenteric vein (No. 14v) lymph node dissection for lower-third gastric cancer: a propensity score-matched case–control study

Endoscopic gastrojejunostomy revision is more effective than medical management alone to address weight regain after RYGB

Minimally invasive endoscopic thyroid surgery using a collar access: experience in 246 cases with the CEViTS technique

Transanal versus abdominal low rectal dissection for rectal cancer: long-term results of the Bordeaux’ randomized trial

Laparoscopic liver resection for metastatic melanoma

Factors affecting the effectiveness and safety of submucosal tunneling endoscopic resection for esophageal submucosal tumors originating from the muscularis propria layer